ENPP2 and metabolic dysfunction-associated steatohepatitis: On the other hand, serum ATX levels are similarly increased in (pathological) conditions without itch, including regular pregnancy, some cancer entities and chronic viral hepatitis B and C. In several liver diseases accompanied by liver fibrosis (but not itch), serum ATX levels can also act as a marker of severity of liver injury [including non-alcoholic steatosis hepatitis (NASH) (114), PBC and PSC (115, 116), hepatitis B (117) and hepatitis C (118)].